scholarly journals Balancing revenue generation with capacity generation: case distribution, financial impact and hospital capacity changes from cancelling or resuming elective surgeries in the US during COVID-19

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Joseph E. Tonna ◽  
Heidi A. Hanson ◽  
Jessica N. Cohan ◽  
Marta L. McCrum ◽  
Joshua J. Horns ◽  
...  
Keyword(s):  
Intensive Care ◽  
Elective Surgery ◽  
Cohort Analysis ◽  
Financial Impact ◽  
Infection Prevalence ◽  
Intensive Care Patients ◽  
Retrospective Cohort Analysis ◽  
Hospital Revenue ◽  
Bed Capacity ◽  
Case Distribution

Abstract Background To increase bed capacity and resources, hospitals have postponed elective surgeries, although the financial impact of this decision is unknown. We sought to report elective surgical case distribution, associated gross hospital revenue and regional hospital and intensive care unit (ICU) bed capacity as elective surgical cases are cancelled and then resumed under simulated trends of COVID-19 incidence. Methods A retrospective, cohort analysis was performed using insurance claims from 161 million enrollees from the MarketScan database from January 1, 2008 to December 31, 2017. COVID-19 cases were calculated using Institute for Health Metrics and Evaluation models. Centers for Disease Control (CDC) reports on the number of hospitalized and intensive care patients by age estimated the number of cases seen in the ICU, the reduction in elective surgeries and the financial impact of this from historic claims data, using a denominator of all inpatient revenue and outpatient surgeries. Results Assuming 5% infection prevalence, cancelling all elective procedures decreases ICU overcapacity from 160 to 130%, but these elective surgical cases contribute 78% (IQR 74, 80) (1.1 trillion (T) US dollars) to inpatient hospital plus outpatient surgical gross revenue per year. Musculoskeletal, circulatory and digestive category elective surgical cases compose 33% ($447B) of total revenue. Conclusions Procedures involving the musculoskeletal, cardiovascular and digestive system account for the largest loss of hospital gross revenue when elective surgery is postponed. As hospital bed capacity increases following the COVID-19 pandemic, restoring volume of these elective cases will help maintain revenue. In these estimates, adopting universal masking would help to avoid overcapacity in all states.

scholarly journals Balancing revenue generation with capacity generation: Case distribution, financial impact and hospital capacity changes from cancelling or resuming elective surgeries in the US during COVID-19

2020 ◽  
Author(s):  
Joseph E. Tonna ◽  
Heidi A. Hanson ◽  
Jessica N. Cohan ◽  
Marta L. McCrum ◽  
Joshua J. Horns ◽  
...  
Keyword(s):  
Intensive Care ◽  
Elective Surgery ◽  
Cohort Analysis ◽  
Open Science ◽  
National Institutes Of Health ◽  
Financial Impact ◽  
Infection Prevalence ◽  
Competing Interests ◽  
Bed Capacity ◽  
Case Distribution

AbstractBackgroundTo increase bed capacity and resources, hospitals have postponed elective surgeries, although the financial impact of this decision is unknown. We sought to report elective surgical case distribution, associated gross hospital earnings and regional hospital and intensive care unit (ICU) bed capacity as elective surgical cases are cancelled and then resumed under simulated trends of COVID-19 incidence.MethodsA retrospective, cohort analysis was performed using insurance claims from 161 million enrollees from the MarketScan database from January 1, 2008 to December 31, 2017. COVID-19 cases were calculated using a generalized Richards model. Centers for Disease Control (CDC) reports on the number of hospitalized and intensive care patients by age were used to estimate the number of cases seen in the ICU, the reduction in elective surgeries and the financial impact of this from historic claims data, using a denominator of all inpatient revenue and outpatient surgeries.ResultsAssuming 5% infection prevalence, cancelling all elective procedures decreases ICU overcapacity from 340% to 270%, but these elective surgical cases contribute 78% (IQR 74, 80) (1.1 trillion (T) US dollars) to inpatient hospital plus outpatient surgical gross earnings per year. Musculoskeletal, circulatory and digestive category elective surgical cases compose 33% ($447B) of total revenue.ConclusionsProcedures involving the musculoskeletal, cardiovascular and digestive system account for the largest loss of hospital gross earnings when elective surgery is postponed. As hospital bed capacity increases following the COVID-19 pandemic, restoring volume of these elective cases will help maintain revenue.DECLARATIONSEthics approval and consent to participateThis study did not meet criteria for IRB review.Consent for publicationNot applicableAvailability of data and materialsTo facilitate research reproducibility, replicability, accuracy and transparency, the associated analytic code is available on the Open Science Foundation [1] (OSF) repository, [DOI 10.17605/OSF.IO/U53M4] at [https://osf.io/u53m4]. The data that support the findings of this study were obtained under license from Truven. Data were received de-identified in accordance with Section 164.514 of the Health Insurance Portability and Accountability Act (HIPAA).Competing interestsJET received modest financial support for speakers fees from LivaNova and from Philips Healthcare, outside of the work. The other authors declare that they have no competing interests.FundingJET is supported by a career development award (K23HL141596) from the National Heart, Lung, And Blood Institute (NHLBI) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. None of the funding sources were involved in the design or conduct of the study, collection, management, analysis or interpretation of the data, or preparation, review or approval of the manuscript.Authors’ contributionsJET, JH had full access to all the data in the study, takes responsibility for the integrity of the data, the accuracy of the data analysis, and the integrity of the submission as a whole, from inception to published article. JET, HH, BSB, JC, MM, JJH, JH conceived study design; JET, HH, BSB, JC, MM, JJH, RD, BK, AJC, JH contributed to data acquisition and analysis; JET, HH, JJH, JH drafted the work; all authors revised the article for important intellectual content, had final approval of the work to be published, and agree to be accountable to for all aspects of the work.AcknowledgementsNot applicable

scholarly journals Do we need to enlarge emergency services or new emergency hospitals?

2021 ◽  
Vol 8 (5) ◽  
pp. 329-333
Author(s):  
Ensar Durmuş ◽  
Fatih Güneysu
Keyword(s):  
Intensive Care ◽  
Emergency Room ◽  
Emergency Services ◽  
Cross Sectional ◽  
Average Hospital ◽  
Emergency Admissions ◽  
Prolonged Length ◽  
Intensive Care Patients ◽  
Number Of Patients ◽  
Bed Capacity

Objective: It was aimed to obtain a notion about the needed hospital bed capacity by analyzing the number of hospitalizations and referrals from the ER in this study. Material and Method: This study is a retrospective, analytical cross-sectional research. Patients admitted to a tertiary hospital’s adult emergency service in 2018-2019, hospitalized, or referred to another hospital were analyzed. Results: Of the patients, 28036 were hospitalized; furthermore, this number corresponded to 38.4 patients per day. Of these cases, 15303 (54.6%) were male, and the mean age was 57.89 (±19.5); 8438 cases (30.1%) were admitted to the intensive care unit. The department with the most hospitalizations was internal medicine with 6105 patients (21.78%) and cardiology, with 4822 hospitalized, the most intensive care patients; moreover, psychiatry had the most prolonged length of stay service average of 28 days. The number of patients required to be hospitalized from the emergency room was an average of 48.5 patients per day. The average hospital stay was seven days. Conclusion: Mainly in regions with several emergency admissions, it can be considered to establish emergency hospitals that serve particularly emergency cases to engage the number of patients to be hospitalized from the emergency room.

scholarly journals Trends in Mortality in an Australian Tertiary Surgical Neonatal Intensive Care Unit

2018 ◽  
Vol 7 (1) ◽  
pp. 4
Author(s):  
Joseph Kiran Tauro ◽  
Karen Walker ◽  
Robert Halliday ◽  
Vishal Jatana ◽  
Amit Trivedi
Keyword(s):  
Intensive Care ◽  
Birth Weight ◽  
Mortality Rate ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Cohort Analysis ◽  
Retrospective Cohort Analysis ◽  
Surgical Condition ◽  
Neonatal Population ◽  
Median Birth Weight

Aim: The aim of the study was to estimate mortality rate and trend in the neonate admitted to a surgical neonatal intensive care unit.Methods: This study was a retrospective cohort analysis of all neonatal (from birth toResults: There were a total of 8994 admissions with 425 deaths during the study period, of whom 328 infants met inclusion criteria. In this group 18.9% (n=62) were admitted for a surgical condition, 35.4% (n=116) for cardiac disease and 45.7% (n=150) for other reasons. The median birth weight was 2715g (IQR 1890g-3220g) and the median gestational age was 37 weeks (IQR 33-39 weeks). The inter-quartile range for length of stay was between 2 to 20 days. The overall mortality rate was 3.6% over 16 years. There was a decline in mortality rate from 5.9% in 2000 to 3.5% in 2015 (p=0.06). Female infants accounted for 41% of the deaths. On multivariate analysis only very low birth weight was an independent predictor of mortality for surgical and cardiac deaths compared to deaths by other cause.Conclusions: There has been an overall decline in mortality in the surgical neonatal population from 2000 to 2015.

scholarly journals The weekend effect for stroke patients admitted to intensive care: A retrospective cohort analysis

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0234521
Author(s):  
William Greig Mitchell ◽  
Rohit Pande ◽  
Tom Edward Robinson ◽  
Gabriel Davis Jones ◽  
Isabella Hou ◽  
...  
Keyword(s):  
Intensive Care ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Weekend Effect ◽  
Stroke Patients ◽  
Retrospective Cohort Analysis

scholarly journals Patient or family perceived deterioration in functional status and outcome after intensive care admission: a retrospective cohort analysis of routinely collected data

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039416
Author(s):  
Jamie L Gross ◽  
Jacek Borkowski ◽  
Stephen J Brett
Keyword(s):  
Intensive Care ◽  
Hospital Discharge ◽  
Cohort Analysis ◽  
North West ◽  
Icu Admission ◽  
Routinely Collected Data ◽  
Retrospective Cohort Analysis ◽  
Mortality Outcome ◽  
Data Source ◽  
Functional Deterioration

ObjectiveTo explore the association of patient or family reported functional deterioration (defined by a single question) in the preceding year, with mortality outcome for those admitted to the intensive care unit (ICU).DesignRetrospective observational analysis of a routinely collected data source.ParticipantsPatients that were admitted to the ICU at Northwick Park and St Marks Hospitals, London North West University Healthcare NHS Trust between 01 October 2017 to 15 June 2019 were included. Patients were excluded if they had a prior ICU admission during the existing hospital episode or if information on functional deterioration could not be retrieved from either the patient or their advocate.Primary outcomesMortality at the point of hospital discharge and 1 year following admission to the ICU.ResultsOf the 1006 patients who were admitted to the ICU during the study period, information on functional deterioration was available for 621 patients who were included in the analysis. From these, 251 (40.4%) patients had patient or family reported functional deterioration in the preceding year, while 370 (59.6%) patients had a perceived stable functional baseline. Comparing the two groups, mortality was significantly higher in those who had functionally deteriorated compared with those with stable baseline function, at the point of hospital discharge (45.4% vs 25.9%; p<0.0001) and at 1 year (59.4% vs 33.0%; p<0.0001).ConclusionPatient or family reported functional deterioration was significantly associated with higher mortality at the point of hospital discharge and at 1 year. The concept of functional deterioration in the lead up to ICU admission warrants further exploration.

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